From the Guidelines
The initial approach to cardiac assessment should start with a thorough history and physical examination, followed by a resting electrocardiography (ECG) for risk assessment, as recommended by the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons 1.
Key Components of Cardiac Assessment
- A thorough history and physical examination to assess the probability of ischemic heart disease (IHD) prior to additional testing, as recommended by the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons 1
- Resting electrocardiography (ECG) for risk assessment in patients without an obvious noncardiac cause of chest pain, as recommended by the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons 1
- Consideration of stress testing, such as standard exercise ECG or exercise stress with radionuclide myocardial perfusion imaging or echocardiography, for patients with an intermediate to high pretest probability of IHD, as recommended by the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons 1 and the European Society of Cardiology 1
Additional Diagnostic Tests
- Point-of-care ultrasound for rapid evaluation of cardiac function and fluid status
- Basic laboratory tests, such as cardiac biomarkers (troponin), electrolytes, and complete blood count
- Consideration of advanced tissue imaging modalities, such as cardiac magnetic resonance imaging, for assessment of cardiac function and myocardial fibrosis, as recommended by the American Heart Association 1
Importance of Comprehensive Cardiac Risk Assessment
- A comprehensive cardiac risk assessment is crucial prior to liver transplantation, as cardiovascular disease is a leading cause of early death and cardiac events in liver transplant recipients, as highlighted by the European Association for the Study of the Liver 1
- The assessment should include electrocardiogram, transthoracic echocardiogram, and consideration of invasive coronary imaging for patients at high risk of significant coronary artery disease, as recommended by the European Association for the Study of the Liver 1
From the Research
Initial Approach to Cardiac Assessment
The initial approach to cardiac assessment involves a combination of patient history, physical examination, and diagnostic tests.
- Patient history and physical examination are crucial in identifying patients with suspected coronary artery disease, as they provide important information about the presence, extent, and severity of myocardial ischemia 2.
- The electrocardiogram (ECG) is an essential part of the initial evaluation of patients with symptoms suspected to be related to myocardial ischemia, along with focused history and physical examination 2.
- Elements of patient history, such as pain radiating to both arms, and physical examination findings, such as pulmonary rales, can increase the probability of major adverse cardiac events (MACE) within 30 days 3.
- Diagnostic tests, such as stress testing, echocardiography, and coronary computed tomographic angiography (CTA), can be used to further evaluate patients with suspected coronary artery disease.
Diagnostic Tests
- Stress testing is often employed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for cardiac catheterization 4.
- Echocardiography is highly reliable for assessing cardiac wall motion and can be used for diagnosis and risk assessment in patients presenting to the emergency department with symptoms suggestive of myocardial ischemia 5.
- Coronary CTA has shown great technological improvements over the last 2 decades and has high accuracy in detecting significant coronary stenosis, making it a potential substitute for conventional invasive coronary angiography in patients with suspected coronary artery disease 6.
Risk Assessment
- Patient history and physical examination can provide important information about the risk of major adverse cardiac events (MACE) within 30 days 3.
- Diagnostic tests, such as coronary CTA, can provide a complete assessment of coronary artery disease, including anatomy, functionality, and plaque composition, which can support risk management for both primary and secondary cardiovascular prevention 6.